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Stress Doppler echocardiography of the internal thoracic artery – a new non-invasive approach for functional assessment after minimally invasive coronary bypass grafting

^a Faculty of Medicine, University of Witten-Herdecke, Department of Cardiology and Internal Medicine, General Hospital Solingen, Germany
^b Department of Cardiac and Thoracic Surgery, Heart Center Voelklingen, Germany
^c Department of Thoracic and Cardiovascular Surgery, Heinrich-Heine-University, Düsseldorf, Germany
^d Department of Cardiology, Pneumology and Angiology, Heinrich-Heine-University, Düsseldorf, Germany
^e Department of Cardiology, Heart Center Wuppertal, University of Witten-Herdecke, Germany

*Corresponding author. Klinik für Kardiologie, Fachklinik Rhein/Ruhr, Auf der Rötsch 2, 45219 Essen, Germany. Tel.: +49-20254-880; fax: +49-2104 809513.

E-mail address: RogerMarx{at}t-online.de (R. Marx).

Minimally invasive surgery for coronary revascularization using the left internal thoracic artery (ITA) has gained increasing interest. For control of graft function the established transcutaneous color-Doppler echocardiography in combination with a stress-test was performed to test the ability of this novel technique. Twenty-one patients having received a single ITA-graft were evaluated early postoperatively at rest and during isometric stress test with a handgrip exercise. Compared to the right internal thoracic artery, the mainly systolic flow is changed to a wide diastolic component when the left ITA is anastomosed to the coronary artery. The peak systolic/peak diastolic velocity ratio changed from 4.5±1.9 to 1.4±0.47 (P<0.0001). During stress reaction with the isometric handgrip maneuver the grafted ITA showed a significant increase of the mean diastolic flow (29.1±13.3 to 44.3±14.7 cm/s, P<0.0001) and total blood flow (124.8±55.4 ml/min to 176.6±71.7 ml/min), which may demonstrate an efficient bypass function. We conclude, that the noninvasive measurement of ITA-graft function with Doppler-ultrasound may be a clinically useful method to assess the functional status after minimally invasive coronary artery bypass grafting. In combination with the hand-grip test it represents a valid new technique with the potential to estimate graft patency.

Key Words: Internal thoracic artery bypass; Stress Doppler echocardiography; Minimally invasive cardiac surgery

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